%0 Journal Article
%T Choroidal Metastasis from Follicular Cell Thyroid Carcinoma Masquerading as Circumscribed Choroidal Haemangioma
%A V. P. Papastefanou
%A A. K. Arora
%A J. L. Hungerford
%A V. M. L. Cohen
%J Case Reports in Oncological Medicine
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/251817
%X Choroidal metastases from follicular thyroid carcinoma are uncommon and usually present as an amelanotic lesion against a background of known systemic disease. We present the case of a 56-year-old woman with a thyroid metastatic focus with unusual clinical presentation, systemic involvement, and early response to systemic treatment. A review of the literature accompanies this case presentation. 1. Case Presentation A 56-year-old lady was referred to the Ocular Oncology Service with a seven-year history of deteriorating visual acuity in the left eye. Patient had a 15-year history of sarcoidosis associated with recurrent uveitis. Best-corrected visual acuity was at 6/36£żOS 6/6£żOD. At presentation there was no active uveitis. Posterior segment examination revealed an elevated lesion inferotemporally to the macula of the left eye measuring 6.5 ĦÁ 6.8£żmm that was pale orange in colour and difficult to discern clinically from the surrounding retina (Figure 1(a)). A fundus fluorescein angiogram indicated early hyperfluorescence. B-scan ultrasound demonstrated a dome-shaped lesion with high internal reflectivity measuring 2.7£żmm in elevation. A Doppler B-scan ultrasound indicated the presence of internal blood flow. Clinical appearance at presentation was typical of a circumscribed choroidal haemangioma although a metastatic deposit remained within the differential diagnosis. No ocular treatment was performed but review was arranged in 3 months pending ongoing investigations for a thyroid gland mass discovered on a routine CT scan of the neck and chest. Figure 1: (a) Pale orange lesion involving the macula and extending inferotemporally before treatment. Clinical appearance is consistent with a circumscribed choroidal haemangioma. (b) After four months a pale, fibrotic scar has developed in the site of the original lesion following treatment. Thyroid gland biopsy proved the mass was a follicular cell carcinoma of the thyroid and systemic staging revealed stage 4 disease due to the presence of bone metastases in the left iliac crest and in the right femur, the latter causing a pathologic fracture. Patient underwent total thyroidectomy. Excision was incomplete and patient received 2 initial sessions of adjuvant treatment of radioactive iodine (131I) therapy (4.9 and 5.8£żGBq, resp.). The pathologic fracture was managed with internal fixation and adjuvant external beam radiotherapy (EBRT) with 35£żGy at 15 sessions in the iliac crest and 20£żGy in the femur. Following radioactive treatment of the thyroid gland the visual acuity reduced to counting fingers. Fundus
%U http://www.hindawi.com/journals/crionm/2014/251817/